Original Research: Critical Care |

Short- vs Long-Duration Antibiotic Regimens for Ventilator-Associated PneumoniaOptimization of Treatment Duration for VAP: A Systematic Review and Meta-analysis

George Dimopoulos, MD, PhD; Garyphallia Poulakou, MD, PhD; Ioannis A. Pneumatikos, MD, PhD; Apostolos Armaganidis, MD, PhD; Marin H. Kollef, MD, FCCP; Dimitrios K. Matthaiou, MD
Author and Funding Information

From the Department of Critical Care (Drs Dimopoulos, Armaganidis, and Matthaiou), and the 4th Department of Internal Medicine (Dr Poulakou), Medical School, University of Athens, “Attikon” University Hospital, Athens, Greece; The Department of Intensive Care (Dr Pneumatikos), Medical School, Democritus University of Thrace, Alexandroupolis University Hospital, Alexandroupoli, Greece; and the Division of Pulmonary and Critical Care Medicine (Dr Kollef), Washington University School of Medicine, St. Louis, MO.

Correspondence to: Dimitrios K. Matthaiou, MD, Department of Critical Care, “Attikon” University Hospital, 1 Rimini St, 124 62, Chaidari, Athens, Greece; e-mail: d.matthaiou@gmail.com

For editorial comment see page 1745

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;144(6):1759-1767. doi:10.1378/chest.13-0076
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Background:  We performed a systematic review and meta-analysis of short- vs long-duration antibiotic regimens for ventilator-associated pneumonia (VAP).

Methods:  We searched PubMed and Cochrane Central Registry of Controlled Trials. Four randomized controlled trials (RCTs) comparing short (7-8 days) with long (10-15 days) regimens were identified. Primary outcomes included mortality, antibiotic-free days, and clinical and microbiologic relapses. Secondary outcomes included mechanical ventilation-free days, duration of mechanical ventilation, and length of ICU stay.

Results:  All RCTs included mortality data, whereas data on relapse and antibiotic-free days were provided in three and two out of four RCTs, respectively. No difference in mortality was found between the compared arms (fixed effect model [FEM]: OR = 1.20; 95% CI, 0.84-1.72; P = .32). There was an increase in antibiotic-free days in favor of the short-course treatment with a pooled weighted mean difference of 3.40 days (random effects model: 95% CI, 1.43-5.37; P < .001). There was no difference in relapses between the compared arms, although a strong trend to lower relapses in the long-course treatment was observed (FEM: OR = 1.67; 95% CI, 0.99-2.83; P = .06). No difference was found between the two arms regarding the remaining outcomes. Sensitivity analyses yielded similar results.

Conclusions:  Short-course treatment of VAP was associated with more antibiotic-free days. No difference was found regarding mortality and relapses; however, a strong trend for fewer relapses was observed in favor of the long-course treatment, being mostly driven by one study in which the observed relapses were probably more microbiologic than clinical. Additional research is required to elucidate the issue.

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